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Eaton M, Probst Y, Foster T, Messore J, Robinson L. A systematic review of observational studies exploring the relationship between health and non-weight-centric eating behaviours. Appetite 2024; 199:107361. [PMID: 38643903 DOI: 10.1016/j.appet.2024.107361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/22/2024] [Accepted: 04/13/2024] [Indexed: 04/23/2024]
Abstract
Eating behaviour that does not centralise weight, otherwise known as weight-neutral, is associated with improved physical and psychological health, and greater health promoting behaviours. However, consolidated evidence is lacking. This study aimed to systematically evaluate 'health-centric' eating behaviour reflective of weight-neutral approaches, and their relationship with health (physical and mental) and health promoting behaviours. A systematic search was performed, identifying observational studies with adult populations, ≥1 physical/mental health outcome(s), and ≥1 validated measure(s) of health-centric eating behaviour. Study design, sample characteristics and outcomes were extracted and characterised into four domains. Our search identified 8281 records, with 86 studies, 75 unique datasets, and 78 unique exposures including 94,710 individuals. Eating behaviours included intuitive eating (n = 48), mindful eating (n = 19), and eating competence (n = 11). There were 298 outcomes identified for body composition, size, and physical health (n = 116), mental health and wellbeing (n = 123), health promoting behaviours (n = 51) and other eating behaviour (n = 8). Higher levels of intuitive eating, mindful eating and eating competence were significantly related to a lower BMI, better diet quality and greater physical activity. Higher intuitive and mindful eating were significantly related to lower levels of disordered eating, and depressive symptoms, and greater body image, self-compassion, and mindfulness. Greater eating competence and intuitive eating were significantly related to higher fruit and vegetable intake, and greater eating competence to higher fibre intake and better sleep quality. Our results demonstrate that 'health-centric' eating behaviours are related to a range of favourable health outcomes and engagement in health promoting behaviours. These findings help to enhance our understanding of eating behaviours that do not centre around body weight, providing support for health-centric eating behaviour in healthcare. Future research should focus on intervention studies and more diverse population groups.
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Affiliation(s)
- Melissa Eaton
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, Australia.
| | - Yasmine Probst
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, Australia
| | - Tiarna Foster
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, Australia
| | - Julia Messore
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Laura Robinson
- School of Psychology, University of Wollongong, Wollongong, Australia
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Mensinger JL, Shepherd BF, Schapiro S, Aware Y, Brochu PM, Calogero RM, Tylka TL. Mediating effects of a weight-inclusive health promotion program on maladaptive eating in women with high body mass index. Eat Behav 2023; 49:101730. [PMID: 37121132 DOI: 10.1016/j.eatbeh.2023.101730] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 02/14/2023] [Accepted: 04/17/2023] [Indexed: 05/02/2023]
Abstract
Research shows that individuals with a body mass index (BMI) over 30 have experienced an 11-fold increase in restrictive eating and a 7-fold increase in binge eating since the 1990s. Most health promotion programs for higher-weight individuals have not been developed with the high eating disorder risk for this population in mind. The purpose of current study was to test two hypothesized mechanisms underlying improvement in maladaptive eating patterns shown in a weight-inclusive health promotion program designed for women with BMIs at or above 30. Participants (N = 40) were primarily White (93 %), 30-45 years old (M = 39.83, SD = 4.34) with BMIs ranging from 30 to 45 kg/m2 (M = 37.42, SD = 3.58). Using the MEMORE macro, we tested a parallel mediation model hypothesizing that internalized weight stigma and intuitive eating would explain improvements on two subscales from the Three-Factor Eating Questionnaire-R18 after a 6-month program. Total effects of the program on uncontrolled (b = -3.76, SE = 0.64, p < .0001) and emotional eating (b = -1.79, SE = 0.34, p < .0001) were significant. The indirect effects (IE) of internalized weight stigma on uncontrolled eating (IE = 1.59, SE = 0.79, 95 % CI = 0.46, 3.49) and emotional eating (IE = 0.67, SE = 0.40, 95 % CI = 0.11, 1.68) were also significant. Likewise, the IEs of intuitive eating on uncontrolled eating (IE = 2.09, SE = 0.70, 95 % CI = 0.60, 3.38) and emotional eating (IE = 1.03, SE = 0.43, 95 % CI = 0.08, 1.82) were significant. These findings indicate that weight-inclusive health promotion programs that directly address weight bias and eating according to cues from the body may help higher-weight individuals improve maladaptive eating patterns via reductions in internalized weight stigma and increases in intuitive eating.
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Affiliation(s)
- Janell L Mensinger
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Benjamin F Shepherd
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Stevie Schapiro
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Yashvi Aware
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Paula M Brochu
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Rachel M Calogero
- Department of Psychology, Western University, Westminster Hall, Office 321, London, ON N6K 5C2, Canada.
| | - Tracy L Tylka
- Department of Psychology, The Ohio State University, 170F Morrill Hall, 1465 Mt. Vernon Avenue, Marion, OH 43302, United States of America.
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Braun TD, Olson K, Panza E, Lillis J, Schumacher L, Abrantes AM, Kunicki Z, Unick JL. Internalized weight stigma in women with class III obesity: A randomized controlled trial of a virtual lifestyle modification intervention followed by a mindful self-compassion intervention. Obes Sci Pract 2022; 8:816-827. [PMID: 36483124 PMCID: PMC9722463 DOI: 10.1002/osp4.616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 11/11/2022] Open
Abstract
Background Internalized weight stigma (Internalized-WS) is prevalent among individuals with severe obesity, particularly women, and is associated with shame, disordered eating, and weight gain. Effective, accessible interventions that address both severe (Class-III) obesity and Internalized-WS are needed. This randomized pilot trial evaluated the feasibility, acceptability, and preliminary efficacy of a fully-remote lifestyle modification intervention (LM) followed by mindful self-compassion training (MSC) or control. Methods Twenty-eight women with Class-III obesity (46.6 ± 3.7 kg/m2) and elevated Internalized-WS were randomized to a virtually-delivered 4-month LM followed by a 2-month MSC or cooking/dietary education (CON). Psychosocial measures/weight were assessed at baseline, 4-(post-LM), 6-(post-MSC/CON), and 9-month (follow-up). Results Improvements in Internalized-WS, shame, and self-compassion were observed with LM. Mean 4-month weight loss was 6.3 ± 3.7%. MSC had lower attendance and usefulness ratings versus CON. Post-MSC/CON, MSC yielded significant and/or meaningful improvements in Internalized-WS, self-compassion, and intuitive eating relative to CON. Weight loss did not differ by group at 6-month, and at 9-month trended lower in MSC versus CON. Conclusion Virtual LM is feasible, acceptable, and leads to significant weight loss among women with severe obesity; MSC led to further improved Internalized-WS, self-compassion, and intuitive eating. Continued work is needed to elucidate effects of self-compassion training on Internalized-WS, its mechanisms, and linkages to cardiometabolic health and long-term weight loss.
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Affiliation(s)
- Tosca D. Braun
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Centers for Behavioral and Preventive MedicineThe Miriam HospitalProvidenceRIUSA
- Butler HospitalProvidenceRIUSA
| | - Kayloni Olson
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRIUSA
| | - Emily Panza
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRIUSA
| | - Jason Lillis
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRIUSA
| | - Leah Schumacher
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRIUSA
| | - Ana M. Abrantes
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Butler HospitalProvidenceRIUSA
| | - Zachary Kunicki
- Quantitative Sciences ProgramBrown UniversityProvidenceRIUSA
| | - Jessica L. Unick
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRIUSA
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Estey EEE, Roff C, Kozlowski MB, Rovig S, Guyker WM, Cook-Cottone CP. Efficacy of Eat Breathe Thrive: A randomized controlled trial of a yoga-based program. Body Image 2022; 42:427-39. [PMID: 35985168 DOI: 10.1016/j.bodyim.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/21/2022]
Abstract
Evidence positions yoga as a promising intervention for enhancing positive embodiment and supporting the prevention of, and recovery from, eating disorders (EDs) by reducing ED symptomatology and building skills that facilitate an ongoing, embodied sense of wellbeing. However, yoga-based programs are few and rigorous literature on their efficacy is limited. This study examined the efficacy and feasibility of a yoga-based program called Eat Breathe Thrive (EBT) which aims to prevent EDs and support embodiment. Participants (N = 168, 93.5 % women) from a community sample in the United States and United Kingdom, ages 18-65, were randomly allocated to a 2-h, 7-week EBT program or waitlist-control condition. Compared to controls, EBT participants experienced significant decreases in ED behaviors, depression, and difficulties regulating emotions. They reported significantly greater use of mindfulness skills, such as interoceptive awareness, mindful self-care, and mindful eating. After a single session, participants reported immediate improvement in their sense of well-being, indicating increased state positive embodiment. Most effects were sustained at 6-month follow-up. The majority of individuals attended most sessions. Self-reported treatment integrity was excellent. Directions for future research are proposed. Results support the efficacy and feasibility of an integrated yoga intervention that fosters positive ways of inhabiting the body.
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Braun TD, Puhl RM, Quinn DM, Gorin A, Tishler D, Papasavas P. Weight stigma and posttraumatic stress disorder symptoms in individuals seeking bariatric surgery. Surg Obes Relat Dis 2022; 18:1066-1073. [PMID: 35811291 PMCID: PMC9797255 DOI: 10.1016/j.soard.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/13/2022] [Accepted: 05/10/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND After bariatric surgery, some patients experience adverse psychiatric outcomes, including substance use, suicidality, and self-harm. These factors are commonly associated with posttraumatic stress disorder (PTSD) and related symptoms (PTSD-S) that develop following adverse childhood experiences (ACEs) and traumatic events. However, emerging evidence suggests that chronic discrimination also may contribute to PTSD-S. Weight-based discrimination is salient for people with obesity but has received little attention in relation to PTSD-S. OBJECTIVE Our study examined factors that may contribute to the link between experienced weight stigma (WS), which is common in individuals seeking bariatric surgery, and PTSD-S. SETTING Teaching hospital and surgical weight loss center in the United States. METHODS A total of 217 participants completed self-report surveys of experienced and internalized WS, ACEs, and PTSD-S. Demographics and trauma history were obtained from patient medical records. A stepwise multiple regression examined associations between experienced WS and internalized WS with PTSD-S, co-varying demographics, ACEs, and trauma, followed by examination of whether findings held co-varying anxiety/depressive symptoms in a participant subset (n = 189). RESULTS After accounting for covariates in step 1 and ACEs and trauma in step 2 (ΔR2 = .14), experienced WS and internalized WS accounted for substantial PTSD-S variance in steps 2 and 3 (ΔR2 = .12 and .13, respectively; overall model R2 =.44; P < .001). Findings held after co-varying anxiety/depressive symptoms. CONCLUSIONS Over and above ACEs and trauma, experienced WS and internalized WS may contribute to PTSD-S. Longitudinal research is needed to better elucidate the pathways underlying these associations.
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Affiliation(s)
- Tosca D. Braun
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island,Centers of Preventive Medicine, The Miriam Hospital, Providence, Rhode Island,Butler Hospital, Providence, Rhode Island,Correspondence: Tosca D. Braun, Ph.D., Alpert Brown Medical School, Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906. (T.D. Braun)
| | - Rebecca M. Puhl
- Department of Human Development & Family Sciences, Rudd Center for Food Policy & Obesity, University of Connecticut, Storrs, Connecticut
| | - Diane M. Quinn
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, Connecticut
| | - Amy Gorin
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, Connecticut
| | - Darren Tishler
- Surgical Weight Loss Center, Hartford Healthcare, Hartford, Connecticut
| | - Pavlos Papasavas
- Surgical Weight Loss Center, Hartford Healthcare, Hartford, Connecticut
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Webb JB, Padro MP, Thomas EV, Davies AE, Etzel L, Rogers CB, Heredia NI. Yoga at Every Size: A Preliminary Evaluation of a Brief Online Size-Inclusive Yoga and Body Gratitude Journaling Intervention to Enhance Positive Embodiment in Higher Weight College Women. Front Glob Womens Health 2022; 3:852854. [PMID: 35720811 PMCID: PMC9199427 DOI: 10.3389/fgwh.2022.852854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/11/2022] [Indexed: 11/19/2022] Open
Abstract
The present pilot randomized controlled trial (RCT) evaluated the feasibility, acceptability, and preliminary efficacy of a 4-week online yoga and body gratitude journaling intervention for strengthening positive embodiment among racially-diverse higher weight college women. Seventy-five participants were initially randomized to either the yoga condition (n = 36) or to a wait-list control (n = 39). Participants completed measures of positive and negative body image, weight bias internalization, self-compassion, drive for leanness, and physical activity acceptance at both baseline and post. Preliminary results among the 42 analyzed completers (mean age = 20.9, SD = 2.4; 30% Black or African American) revealed acceptable feasibility given the low-intensity nature of the intervention reflected in a 36% attrition rate. Self-reported adherence was strong for the yoga component with 81% of participants indicating that they practiced with the videos ≥3–4 times per week as suggested. Although 71% reported completing the body gratitude journal ≥1–2 times per week, daily adherence was minimal. Acceptability was also high among participants randomized to the yoga condition as indicated by 86% expressing at least moderate levels of satisfaction with the overall program. Qualitative feedback from participants further supported the acceptability of the program and pointed to important areas in further refining the protocol in the future. Preliminary efficacy was supported by significant reductions in internal body shame and gains in body appreciation, functional body appreciation, functional body satisfaction, functional body awareness, and behavioral commitment to physical activity engagement among the yoga vs. wait-list control participants. These promising findings once replicated in larger, higher-powered trials may have important implications for extending the reach and accessibility of mind-body wellness practices like yoga to benefit racially-/ethnically-diverse college women of higher weight. This research is further responsive to the growing need for efficacious remotely-delivered, and scalable behavioral health interventions in the ongoing era of the COVID-19 pandemic. However, additional research is warranted to explore ways of enhancing engagement of participants with lower levels of positive embodiment and to further incentivize the journaling component of the intervention.
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Affiliation(s)
- Jennifer B. Webb
- Department of Psychology, University of North Carolina at Charlotte, Charlotte, NC, United States
- *Correspondence: Jennifer B. Webb
| | - Meagan P. Padro
- Department of Education, UNC Chapel Hill, Chapel Hill, NC, United States
| | - Erin Vinoski Thomas
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Alexandria E. Davies
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Lena Etzel
- Department of Psychology, University of North Carolina at Charlotte, Charlotte, NC, United States
| | | | - Natalia I. Heredia
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
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Braun TD, Unick JL, Abrantes AM, Dalrymple K, Conboy LA, Schifano E, Park CL, Lazar S. Intuitive eating buffers the link between internalized weight stigma and body mass index in stressed adults. Appetite 2022; 169:105810. [PMID: 34813916 PMCID: PMC9434977 DOI: 10.1016/j.appet.2021.105810] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 11/05/2021] [Accepted: 11/14/2021] [Indexed: 02/03/2023]
Abstract
Internalized weight stigma (IWS) is independently associated with less intuitive eating (i.e., eating based on endogenous hunger/satiety cues) and higher Body Mass Index (BMI), and intuitive eating training is commonly conceptualized as protective against the effects of IWS on poor behavioral health. The 3-way relationship between IWS, intuitive eating, and BMI has yet to be examined, and it is unclear whether the link between IWS and BMI is buffered by high intuitive eating. This secondary preliminary analysis examined baseline data of stressed adults with poor diet (N = 75, 70% female, 64.1% White, 42.7% with overweight/obesity) in a parent clinical trial that tested the effects of yoga on diet and stress. Validated self-report surveys of IWS and intuitive eating were analyzed with objectively-assessed BMI. Moderated regression analyses using the SPSS PROCESS macro tested whether intuitive eating moderated the IWS-BMI link. The analysis revealed IWS was positively associated with BMI except among people with high intuitive eating. Results extend observational findings linking intuitive eating to lower BMI, and offer preliminary support for the hypothesis that this link may hold even among those with greater IWS. It's possible that individuals with lower BMI and greater IWS may gravitate more towards intuitive eating than those with greater BMI, and/or intuitive eating may be an important target for ameliorating the adverse association of IWS with behavioral and physical health indicators linked to BMI. Continued work is warranted in larger, more generalizable samples using causal and prospective designs.
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Affiliation(s)
- Tosca D. Braun
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Storrs, CT 06269-1020,Department of Psychiatry and Human Behavior, Alpert Medical School of Medicine at Brown University,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903
| | - Jessica L. Unick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Medicine at Brown University,Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903
| | - Ana M. Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Medicine at Brown University,Behavioral Medicine and Addictions Research, Butler Hospital
| | - Kristy Dalrymple
- Department of Psychiatry and Human Behavior, Alpert Medical School of Medicine at Brown University,Lifespan Physician’s Group, 146 West River Street, Suite 11B, Providence, RI 02904
| | - Lisa A. Conboy
- Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston MA 02215,New England School of Acupuncture, Massachusetts College of Pharmacy and Health Sciences
| | - Elizabeth Schifano
- Department of Statistics, University of Connecticut, 215 Glenbrook Road U4120, Storrs, CT 06269
| | - Crystal L. Park
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Storrs, CT 06269-1020
| | - Sara Lazar
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, MA,Department of Psychology, Harvard Medical School
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